Provider Demographics
NPI:1609845742
Name:DICHTER, JEFFERY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:R
Last Name:DICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 GOVERN CIR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2460
Mailing Address - Country:US
Mailing Address - Phone:651-271-4463
Mailing Address - Fax:
Practice Address - Street 1:849 GOVERN CIRCLE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55123
Practice Address - Country:US
Practice Address - Phone:651-271-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51484207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200123490AMedicaid
INF15250Medicare UPIN
IN465610XMedicare ID - Type Unspecified